Watch Dr. Houseman Today on WMUR

Posted on May 16, 2017.

Watch our very own Dr. Bryan K. Houseman today on WMUR at noon or 5pm! … Read More

New Hampshire Orthopaedic Center Physicians Named as ‘Top Docs’ for 2017

Posted on March 17, 2017.

Each year, roughly 3,000 physicians licensed to practice in New Hampshire are asked to nominate … Read More

Official Orthopaedic Providers for the Manchester Monarchs

Posted on November 28, 2016.

New Hampshire Orthopaedic Center is proud to extend our partnership with the Manchester Monarchs for … Read More

New Hampshire Orthopaedic Center

Tennis and Golf after Joint Replacement

Posted on March 31, 2017.

by: Kathleen A. Hogan, MD

As the last of the snow melts away, our thoughts turn away from the ski slopes and towards the golf course and the tennis courts. Patients who have had their hips or knees replaced frequently ask if they can safely participate in tennis and golf after joint replacement. Make sure you talk to your surgeon about this before resuming an exercise program after surgery as your doctor may have different recommendations for you.

Return to Full Activity

Return to full activity depends on the type of joint replaced and on the patient. Recovery after a hip replacement is typically faster than after knee replacement. The direct anterior approach to hip replacement limits muscle damage and can be particularly beneficial in those looking for a quick return to activities. However, the bone needs to grow into the implant to stabilize it, and many surgeons recommend waiting at minimum 8 weeks before resuming golf or tennis after a hip replacement. Recovery after knee replacement is slower. Time is needed to recover range of motion and gain strength. Most patients need 3-6 months before they can resume vigorous sporting activities.

Will My Artificial Joint Wear Out?

Joint replacements can wear out, and high impact activities such as running may cause the artificial joint to wear out faster, possibly leading to further surgery. Surveys of joint surgeons show a wide variation in recommendations. However, the majority do allow their patients to resume moderate activity, including golf and doubles tennis.

Stress Placed on Knee by Golf and Tennis

Golf and tennis do place considerable stresses on the knee. For example, driving a golf ball generates equivalent joint reactive forces in the knee as does running, just for a much shorter period of time. In golf, the leading knee absorbs the most stress, while in tennis the forehand generates higher joint contact forces in the knee than does the backhand.

How Will My Knee Perform?

How does having a joint replacement affect your athletic performance? It depends. Surveys of small numbers of patients playing golf after joint replacement show that most patients report a small increase in handicap and a decreased drive distance. Most golfers do not walk the course after joint replacement, and instead choose to use a golf cart. Some notice some mild discomfort during and after playing but a high percentage of patients resumed golfing and were playing the same or increased frequency compared to before their surgery. There is limited data on return to play of tennis players. Many patients feel their level of play improves because their joints no longer hurt.

Expectations About Returning to Tennis and Golf after Joint Replacement

One of the goals of hip and knee replacement is to restore mobility and enable patients to get back to activities they enjoy. However, it may take time to rehabilitate your muscles after surgery. Joint replacements are metal and plastic and are not the same as your original parts. Even after joint replacement your new hip or knee may ache or feel stiff after athletic activity. However most golfers and tennis players indicate that they are able to continue to enjoy their sports following joint replacement. Make sure you talk to your surgeon about your expectations of returning to tennis and golf after hip or knee replacement.

Do Knee Injuries Cause Arthritis?

Posted on February 25, 2017.

by: Kathleen A. Hogan, MD

Watching football on Sunday afternoon, your favorite player twists their knee and lays on the ground. Have they torn a ligament or meniscus? Or will they be back playing later in the game? What impact do knee injuries have on the eventual development of osteoarthritis?

Many Factors Influence Arthritis Development


The development of arthritis is multifactorial. Body weight, leg alignment, and genetic factors all influence the eventual breakdown of joint cartilage. Injuries certainly play a role as well.

Intra-articular fractures which directly damage the joint surface, are the most extreme examples of an injury which has a known increase in the development of arthritis. Even when the pieces are carefully put back in place and fixed with plates and screws, once broken the joint cartilage will never quite be the same.

Injuries to the Meniscus and Ligaments

What about sports injuries to meniscus and ligaments? The meniscus is a crescent shaped, fibro-cartilage structure that is found on the inner and outer side of the knee joint. It helps to dissipate friction and weight bearing forces arcross the knee joint, protecting the articular cartilage. Before the importance of the meniscius was recognized, the treatment for a torn meniscus was to remove it in its entirety. Unfortunately, arthritis often developed many years later. Forty years after a total meniscectomy as a teenager, patients were 4 times more likely to have developed symptomatic arthritis in that knee compared to the non operated knee.

Meniscus Damage

Today, surgeons try to preserve the meniscus as best possible. In younger patients, meniscus repair is sometimes possible. In older patients, only the torn portion of the meniscus is removed. However, the same forces that damaged the meniscus may have also damaged the cartilage of the knee. In one study, 43% of patients (average age 49) undergoing surgery for a torn meniscus were found to have damage to the articular cartilage of the knee, damage that was graded as severe in half of those cases.

Anterior Cruciate Ligament (ACL) Repair

The anterior cruciate ligament (ACL) functions to keep the tibia balanced under the femur during rotational motions. The forces generated during rupture of the ligament often damage the articular cartilage of the knee. Repair of the ligament helps to prevent instability and it is theorized that this protects cartilage from further injury. The type of surgical repair, concurrent meniscus injuries, and patient activity may all influence the development of later arthritis. One Swedish study found a 10% incidence of post traumatic arthritis of the knee 10 years after injury. Other studies have found a much higher rate of arthritis.

Knee Injuries Influence Development of Arthritis

Knee injuries certainly do influence the development of arthritis. A prospective study of 1321 medical students followed for 22 years found that a knee injury as a young adult increased the incidence of knee arthritis from 6% to 13% at age 65. The risk in high performance athletes is likely higher. A retrospective review of athletes at the NFL Combine who had undergone MRI to evaluate prior injuries found evidence of early arthritis in 11% of those with meniscus repair, 24% with ACL repair, and 27% with partial menisectomy!

Preventing Further Injury

Although techniques of repairing damaged articular cartilage, meniscus, and ligaments are improving, injury prevention is the best way to limit cartilage damage in the knee from sports. If you have had a significant injury to your knee in the past, your risk of developing arthritis in that knee is certainly higher, but not inevitable. Just because X-rays may show arthritis, this does not mean that you will require joint replacement surgery. Minimizing further damage by keeping your legs muscles strong, your joints flexible, and your weight within a normal range are very important if you have had prior knee injuries.

How Does Gaining Weight Affect Your Knees?

Posted on January 17, 2017.

by Kathleen A. Hogan, MD

The holidays are a time when many people eat and drink a bit too much and then resolve to lose that weight in the new year. Unfortunately, once weight is gained, it is often difficult to lose. Many people notice that gaining weight seems to affect their joints, causing knee pain. Does excessive body weight cause knee arthritis or just make the symptoms worse?

Relationship Between Body Weight and Knee Arthritis

Symptomatic knee arthritis affects approximately 13% of women and 10% of men over the age of 60 in the United States. There are many causes of knee arthritis including age, injury, mechanical mal-alignment, and genetic factors. Multiple studies have shown a relationship between body weight and the development of knee arthritis. For example, a person with a body mass index (BMI) of over 30 (obese) has an almost 7 times increases in the incidence of knee arthritis compared to someone with a BMI of less than 25 (normal weight). A BMI increase of 5 points is associated with an over 30% increase in the prevalence of knee arthritis.

Impact of Increased Body Weight

How does this increased weight cause knee arthritis? Elevated body weight increases the mechanical stresses on the knee joint. Every 1 pound of weight gained increases the forces on the knee by a factor of 4. Decreased activity many lead to decreased muscle strength which also increases joint reactive forces. Gait analysis studies have shown that the compressive and sheer forces on the tibia-femoral joint are much higher in patients with elevated body mass compared to normal weight individuals. In a study of identical twins, every 1 kg weight gain (2.2 lbs) was found to increase the likelihood of X-ray findings of arthritis in the knee and hands by 9-13%. It is also thought that there may be metabolic and inflammatory factors in patients who are overweight which also contribute to cartilage damage, even in non weight bearing joints such as the hand. Inflammatory cytokines such as TNF alpha and interleukin -1 and adipokines such as leptin and adionectin are elevated in patients with obesity. The role of these factors in the development of arthritis is currently being studied.

Benefits of Loosing Weight

Does losing weight help with knee pain even if you have arthritis? Yes, multiple studies show that weight loss does have beneficial effects, even in patients with x-ray findings of arthritis. Women in the Framingham Knee Osteoarthritis Study who lost weight (BMI decrease of 2 points) significantly decreased their probability of developing knee arthritis. Other studies have shown that when obese patients were able to lose 10% of their body weight, there was a significant improvement in knee pain, physical function, and decreased knee compressive forces with walking. MRIs can also show improvement in knee cartilage with weight loss. The American Academy of Orthopedic Surgeons (AAOS) recommends weight loss through diet and exercise for patients with knee arthritis and a BMI of > 25. Multiple studies have shown the benefit of low impact aerobic exercise and strengthening to improve the symptoms of knee arthritis.

Recommendations for the New Year

Gaining weight can certainly increase the likelihood of developing joint pain and arthritis. If you find yourself putting on a few pounds over the holiday, make sure you stick to your New Years resolution to shed those pounds, as they tend to accumulate if not gotten rid of quickly! While knee arthritis can not always be prevented, low impact exercise, strength training, and maintaining a healthy body weight can help decrease your chance of needing joint replacement in the future.

How Does Body Weight Affect Knee Arthritis?

Posted on December 23, 2016.

by Kathleen A. Hogan, MD

The holidays are a time when many people eat and drink a bit too much and then resolve to lose that weight in the new year. Unfortunately, once weight is gained, it is often difficult to lose. Many people notice that gaining weight seems to affect their joints, causing knee pain. Does excessive body weight cause knee arthritis or just make the symptoms worse?

Relationship Between Body Weight and Knee Arthritis

Symptomatic knee arthritis affects approximately 13% of women and 10% of men over the age of 60 in the United States. There are many causes of knee arthritis including age, injury, mechanical mal-alignment, and genetic factors. Multiple studies have shown a relationship between body weight and the development of knee arthritis. For example, a person with a body mass index (BMI) of over 30 (obese) has an almost 7 times increases in the incidence of knee arthritis compared to someone with a BMI of less than 25 (normal weight). A BMI increase of 5 points is associated with an over 30% increase in the prevalence of knee arthritis.

Impact of Increased Body Weight

How does this increased weight cause knee arthritis? Elevated body weight increases the mechanical stresses on the knee joint. Every 1 pound of weight gained increases the forces on the knee by a factor of 4. Decreased activity many lead to decreased muscle strength which also increases joint reactive forces. Gait analysis studies have shown that the compressive and sheer forces on the tibia-femoral joint are much higher in patients with elevated body mass compared to normal weight individuals. In a study of identical twins, every 1 kg weight gain (2.2 lbs) was found to increase the likelihood of X-ray findings of arthritis in the knee and hands by 9-13%. It is also thought that there may be metabolic and inflammatory factors in patients who are overweight which also contribute to cartilage damage, even in non weight bearing joints such as the hand. Inflammatory cytokines such as TNF alpha and interleukin -1 and adipokines such as leptin and adionectin are elevated in patients with obesity. The role of these factors in the development of arthritis is currently being studied.

Benefits of Losing Weight

Does losing weight help with knee pain even if you have arthritis? Yes, multiple studies show that weight loss does have beneficial effects, even in patients with x-ray findings of arthritis. Women in the Framingham Knee Osteoarthritis Study who lost weight (BMI decrease of 2 points) significantly decreased their probability of developing knee arthritis. Other studies have shown that when obese patients were able to lose 10% of their body weight, there was a significant improvement in knee pain, physical function, and decreased knee compressive forces with walking. MRIs can also show improvement in knee cartilage with weight loss. The American Academy of Orthopedic Surgeons (AAOS) recommends weight loss through diet and exercise for patients with knee arthritis and a BMI of > 25. Multiple studies have shown the benefit of low impact aerobic exercise and strengthening to improve the symptoms of knee arthritis.

Recommendations for the New Year

Gaining weight can certainly increase the likelihood of developing joint pain and arthritis. If you find yourself putting on a few pounds over the holiday, make sure you stick to your New Years resolution to shed those pounds, as they tend to accumulate if not gotten rid of quickly! While knee arthritis can not always be prevented, low impact exercise, strength training, and maintaining a healthy body weight can help decrease your chance of needing joint replacement in the future.

Does Wearing High Heels Damage Your Knees?

Posted on November 27, 2016.

by: Kathleen A. Hogan, MD

It is hard not to notice when a women walks down the street or through the hospital in 3 inch stiletto heels. It is estimated that over 40% of women wear high heals daily. Most of these shoes are not comfortable after several hours of wear and the potential negative effects of tight fitting shoes on the feet are well established. Wearing heels can also cause the muscles in the back of the leg to tighten, making it difficult for some women to place their heel on the ground when walking in flats.

But does wearing high heels do damage to other joints? Women have a higher rate of osteoarthritis of the knee compared to men. It is not well established if this increased incidence is a result of differences in hormone levels, obesity rates, or anatomy. Could wearing high heels increase the risk of arthritis?

Many women who have knee problems will stop wearing high heels because they hurt. Also, many women find as they get older they no longer wish to wear shoes that are not comfortable and that may increase their risk of falls. However, this does not prove that high heels cause arthritis.

Biomechanics of Knee Motion While Wearing High Heels

There are only a few studies that have looked at the biomechanics of knee motion while wearing high heels. In one study, 14 women were asked to walk in sneakers, 1.5 inch heals, and 3 inch heals. As heel height increased, walking speed decreased. Knee flexion increased at heal strike and mid stance. Knee adduction also increased as heel height increased, indicating possibly more reactive forces placed on the knee joint. Other studies have shown increased knee torque and patellofemoral joint reactive forces when high heels are worn.

These studies do not mean that wearing high heels causes arthritis. However, certainly wearing heals will alter gait and may lead to knee pain. Other than wearing sneakers, what can be done to minimize the effects of this increased stress on the knee?

How to Minimize the Effects of Increased Stress on the Knee

Balance is a crucial part of gait. Can you stand on one leg without loosing your balance? Can you do that in heels? When you walk, you spend a portion of your stride with one leg off the ground. If your balance is poor, you will put more stress on the muscles of your hip and knee as you struggle to compensate. Improving balance and strengthening gluteal muscles will take stress off the knees and hips as you walk in heels. Squats and lunges help to improve your dynamic stability.

Standing in heels changes the center of gravity, requiring more effort by the muscles of the low back to keep you standing straight. Core exercises to strengthen the abdominal and low back muscles are essential to maintaining good posture while wearing heels.

Stretching is also important Yixing Teapots. The calf and foot muscles tighten and contract to maintain that position. If these muscles are not routinely stretched and lengthened, they may become permanently contracted and stiff.

Conclusion

Although wearing high heels has been shown to place additional stresses on the feet and knees, there is no definitive proof that these added stresses result in arthritis. The added stress on the knees of being overweight is a much more important factor in the development of knee arthritis than shoe wear. Flexibility and strength are key to maintaining good posture while walking in heels. Limit the height of your heels to shoes you can balance in while standing on one leg. Find shoes that are more comfortable, with a wider toe box and thicker heel if necessary. And never let anyone talk you out of wearing shoes that you love.